Coogan Trust Account Form For Employer

I hereby understand that under the California Law SB 1162, certain payroll companies will withhold a sum equal to 15% (fifteen percent) of the gross earnings of the name of any minor whose name appears below.

This will remain in effect only in connection with his/her services for the Production entitled:

_____________________________________________________________

This deduction will commence effective immediately and shall continue until completion of all services on the above referenced project. Each payroll company hired by Production companies agrees to deposit all sums within fifteen (15) business days of date of check and receipt by each payroll company of the trust account information listed below.

If a court approval is being sought, I am aware that funds cannot be deposited until such court order is issued and bank information is received by payroll company so that it can be submitted with the first deposit. Further, I fully understand that no interest will be accrued or paid while these sums are being held pending the set up of the trust account.

I am aware that in accordance with California Law, payroll companies do not need any authorization to deduct the 15% (fifteen percent) from any minor’s gross earnings and that under California Law it is my responsibility to have the proper blocked trust fund set up prior to the employment of my minor child.

In accordance with the attached trust fund document, please arrange to deposit the referred deduction to the following trust account:

Name of Minor_____________________________ SSN#__________________

Bank Name________________________________ AC#___________________

Routing #__________________________________

Bank Address_____________________________________________________

City_____________________________ State__________ Zip_____________

Attention_____________________________________

I declare under penalty of perjury under laws of the State of California that the foregoing is true and correct.